Provider Demographics
NPI:1760805683
Name:CHETNAKARNKUL, SURAPEE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:SURAPEE
Middle Name:
Last Name:CHETNAKARNKUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3949
Mailing Address - Country:US
Mailing Address - Phone:714-562-0474
Mailing Address - Fax:
Practice Address - Street 1:1770 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2821
Practice Address - Country:US
Practice Address - Phone:310-787-8861
Practice Address - Fax:310-787-8831
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 37648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist